A stakeholder engagement method to inform adaptation of a multicomponent hypertension control program in Ghana: A mixed methods study

BACKGROUND: Hypertension prevalence in Ghana is high, yet diagnosis, treatment, and control rates remain low. The Kaiser Permanente hypertension control program ("Kaiser bundle") has demonstrated success in high-income settings and has been implemented in some low-resource contexts but not in Ghana. This study describes a community-engaged, mixed-methods process to plan the equitable implementation of the Kaiser bundle for hypertension control in Ghanaian primary healthcare centers (PHCs). METHODS: We conducted five iterative workgroup meetings over 9 months with 46 participants, including 15 adults with hypertension, 16 healthcare providers, 6 policymakers, and 9 community leaders and Civil Society Organization representatives. Using semi-structured discussions, human-centered design activities, and surveys. Workgroup transcripts were analyzed using framework-guided rapid turnaround qualitative analysis, applying the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change compilation, and the to identify determinants and generate and specify strategies. Survey ratings informed prioritization of strategies. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to define and organize implementation outcomes, while the Implementation Research Logic Model (IRLM) was used to organize the determinants/strategies and link them to hypothesized mechanisms and outcomes. RESULTS: The Stakeholder groups identified 45 implementation determinants across individual, organizational, and community levels, with barriers such as limited access to care, provider shortages, fragmented health systems, and financial constraints, while facilitators included community partnerships and existing BP screening initiatives. Based on these determinants, the stakeholder groups co-developed 29 discrete implementation strategies targeting the Kaiser bundle components. Strategies emphasized infrastructure strengthening, provider training, community engagement, telemedicine integration, and culturally responsive approaches. The finalized IRLM mapped and linked determinants, strategies, mechanisms, and anticipated outcomes, providing a transparent and equity-focused implementation plan. CONCLUSIONS: Combining community engagement with established implementation science frameworks enabled the development of an implementation plan for adapting the Kaiser bundle in Ghana. This approach offers a replicable model for planning and reporting implementation efforts in low-resource settings and highlights the importance of equity-focused strategies for improving hypertension outcomes.